HSS is nationally ranked No. 1 in orthopedics (for the 14th consecutive year), and No. 2 in rheumatology by U.S. News & World Report (2023-2024). It is also the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS was ranked No. 1 worldwide in orthopedics for a third consecutive year in 2023. HSS physicians serve as team doctors for the New York Giants, New York Knicks, New York Liberty, New York Mets, Long Island Nets and other professional sports teams. 

“We are pleased to make better quality care more convenient for the Long Island community,” said Mark Drakos, MD, medical director of HSS Long Island. “HSS Southampton responds to a steady increase in demand for our highly specialized orthopedic care from eastern Long Island.”

HSS Southampton is the second outpatient location on Long Island for HSS, which completed a major expansion and renovation of its longstanding offices in Uniondale, in Nassau County in 2022. Physicians at the Southampton location will offer expertise in sports medicine, foot and ankle surgery, hand surgery, pain management, physiatry, spinal care and orthopedic trauma. They are the same physicians who see patients at the main hospital in New York City.

“Our team strives to ensure every patient’s experience across all HSS facilities is consistent and exceptional,” said John Finger, senior vice president, HSS Regional Markets. “We look forward to continuing to serve active communities on Long Island by expanding our physical and digital reach to advance their musculoskeletal health and overall quality of life.”

Individuals who are candidates for orthopedic surgery would go to the Upper East Side hospital. “Long Island residents who have surgery in New York City are pleased to have the convenience of scheduling their pre-operative visits and post-operative care on Long Island,” Dr. Drakos noted.

HSS Southampton is located at 56 Flying Point Road in Southampton. In addition to Long Island, HSS has outpatient locations throughout New York, in New Jersey, in Connecticut and in Florida. More information is available at www.hss.edu/longisland.

Millions of ankle and knee injuries occur each year, many as a result of the abrupt movements that are common among athletes. Today, conventional athletic shoes are primarily designed to support vertical movement with cushioning. Most athletic shoes on the market lack the ability to absorb shock from horizontal or rotational forces created by the shoe’s impact against the playing surface during movements such as cutting or pivoting, which can increase risk of injury. To help reduce and ultimately eliminate the potential for injury caused by these types of movements as well as repetitive stress, SEI has developed two technologies, the Smart Spring^TM and Split Sole^TM, that HSS is currently researching and validating to ensure an optimized product for consumer use.

“As a leader in musculoskeletal health, HSS has been driving innovation in foot, ankle and knee safety to reduce the risk of lower extremity injuries,” said Mark C. Drakos, MD, an orthopedic surgeon specializing in disorders of the foot and ankle and assistant team orthopedist for the New York Knicks. “Our collaboration with SEI is a major opportunity to expand our reach in pioneering new sports safety standards in athletic footwear to improve the well-being of everyday active people who want to perform their best.”

To date, HSS has begun to evaluate the safety and effectiveness of the Smart Spring^TM and Split Sole^TM technologies and how well they address the various injury types they are designed to prevent, such as ACL tears, medial tibial stress syndrome (shin splints) and other knee, muscle and ligament strains and sprains. Beyond these initial concepts, HSS and SEI intend to explore other technologies to help minimize injury risk. 

“Our longstanding relationship with HSS has laid the groundwork to position change driven by science within the athletic footwear industry,” said Dan Richard, SEI president. “We will collaborate with HSS on a rigorous safety validation process to test and evaluate our patented technology that will be applied in footwear, equipment and accessories.” 

“The HSS Innovation Institute played a central role in establishing the strategic relationship, bringing together the complimentary skills and competencies of HSS and SEI that have the potential to drive innovation in sports safety,” said Doug Leach, vice president for device innovation at HSS. The HSS Innovation Institute is singularly focused on advancing the field of musculoskeletal care by managing and commercializing the HSS portfolio of novel concepts, inventions, and partnerships.

HSS will be using human subject testing combined with high-accuracy robotic simulation to perform physical assessments of the technology. By utilizing the state-of-the-art Motion Analysis Lab at HSS, clinicians will use 3D motion to capture data tied to joint motion and contact loads when subjects are performing tasks like change-of-direction maneuvers, dynamic run-stop-jump and cutting motions.

This partnership between HSS and SEI has the potential to impact safety across a number of court and field sports for athletes at all levels, including but not limited to basketball, football, soccer and more, while also enhancing safety for those simply looking for better athletic shoes.  

About SEI

SEI is a performance technology company that has expertise in identifying, developing, and commercializing disruptive inventions primarily in the field of sports. Using its portfolio of load management technologies, SEI focuses on developing and licensing innovative footwear (including footwear applying its proprietary SplitSole^TM technology), non-footwear athletic performance products, and protective sports equipment, in each case, intended to help prevent musculoskeletal injuries. https://sports.engineering.

One of the most common overuse injuries is a stress fracture, and the foot is particularly vulnerable, according to Mark C. Drakos, MD, an orthopedic surgeon specializing in foot and ankle injuries at Hospital for Special Surgery (HSS) in New York City and medical director of HSS Long Island in Uniondale.

Repeated impact on a bone that is starting to weaken from overdoing it can eventually lead to a small break or crack. A stress fracture does not cause the bone to shift position. “When people think of bones, they think they’re hard like metal, but the bones in the foot are more like tree branches. They can bend a little bit, and if you bend them enough times, they can crack,” said Dr. Drakos, who is an assistant team orthopedist for the New York Knicks. “The foot is one of the most common locations to sustain a stress fracture because we are constantly on our feet.”

The foot is an anatomical marvel, with 26 small bones, 33 joints and a network of more than 100 muscles, tendons and ligaments that work together to support our body weight, provide stability, and allow movement. Our feet are designed to absorb a tremendous amount of force with every step we take.

Stress fractures are often seen in runners, in athletic people who participate in high-impact repetitive sports and in older people who have weakened bones, Dr. Drakos says. Individuals who don’t rest adequately in between workouts or keep playing a sport despite exhaustion are at increased risk, as are people who take steroids.

David A. Wang, MD, a sports medicine physician at HSS Paramus in New Jersey, saw an increase in stress fractures in people who were inactive during the pandemic lockdown and then resumed an activity too quickly. “The challenge is that when you’ve been inactive for so long, the body gets weaker and cannot handle an activity at the previous intensity,” he explains. “We still want people to be active, and the cliché I always use is ‘slow and steady wins the race.’ The key is to gradually build up your activity to make sure your body can handle the load. If you’ve never run before and want to start running, for example, start with walking first, then jogging and then gradually start running.”

The main symptom of a stress fracture is pain, which generally occurs in the spot where the bone is broken, according to Dr. Drakos. People may also experience swelling and bruising. Anyone who may have suffered a stress fracture is advised to immediately stop any activity that is causing the discomfort. The main treatment for a stress fracture is rest.

For pain that comes on suddenly, people can try using ice and elevating their foot to see if the pain improves. If it doesn’t get better after a few hours or people start experiencing pain on days they’re not working out, the experts recommend seeing a doctor.

A stress fracture is diagnosed based on a discussion with one’s doctor about recent activities, any possible injury and where the pain is felt. The physician will examine the foot and order X-rays. Sometimes a CT scan or MRI is also prescribed to make the diagnosis.

Surgery is rarely needed for a stress fracture, according to Dr. Drakos. “As a general rule, many fractures of the foot can be treated without surgery by wearing protective shoe wear: either an orthopedic boot or a hard-soled shoe. People can generally put weight their foot when wearing the protective footwear.” Most stress fractures heal in four to six weeks.

Dr. Drakos says lifestyle choices and good habits can lower the risk of developing a stress fracture, not only in the foot, but in other bones as well. He says people should support their bone health with adequate consumption of calcium and vitamin D. He has seen many patients who were found to be deficient in vitamin D, which can also affect healing.

He also stresses the importance of wearing supportive shoes. “Flimsy footwear such as flip flops or ballet slippers do not provide adequate support,” he says. “We take more than a million steps a year. So, if you take 5,000 to 10,000 steps a day in shoes that aren’t giving you a lot of support, it’s that much extra stress on your feet with every step you take.”

Past research has indicated the size of an OLT is a predictive factor correlating with successful surgical outcomes. Microfracture or arthroscopic marrow stimulation has demonstrated less success when treating larger OLTs (greater than 150mm), whereas Osteochondral Autograft Transplantation (OAT) has been successful in treating larger lesions.

A new retrospective study from Hospital for Special Surgery (HSS) compared clinical outcomes after treatment of medium-sized OLTs using a microfracture technique augmented with extracellular matrix and bone marrow aspirate concentrate (MFX) versus OAT to determine which option is superior for treating medium-sized lesions. Fifty patients were evaluated, 27 of whom were treated with MFX, and 23 who were treated with OAT for an OLT (sized 80-165mm) between 2015-2018, at a minimum of 12 months follow up. Patient-reported functional outcomes were collected through the HSS prospective registry database. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score.

The OAT group had a higher MOCART score indicating that the use of a single osteochondral autograft plug may result in better structural repair. Higher average FAOS scores, better than average PROMIS scores and greater pre-to-postoperative change in the OAT group also suggest functional results may be better in this group as well. Patients treated with OAT reported significantly less pain and depression and better psychological benefits than those who were treated with MFX.

“The key takeaways from this research are the open procedure more closely replicates the normal anatomy than the arthroscopic procedure - they are not equal,” said Mark C. Drakos, MD, HSS foot and ankle surgeon and senior study author. “The findings validate the need to perform additional research to ensure the less invasive arthroscopic procedure has better outcomes similar to those of the open procedure.”

This study is available online as part of the AAOS 2020 Virtual Education Experience.

Abstract Title: A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus

Authors: Taylor Cabe, Carolyn M. Sofka, MD, Jonathan T. Deland, MD, Mark C. Drakos, MD

“Normally, patients undergoing Achilles surgery take a year to return to sport. We are hoping to cut that down by at least 30% and potentially make patients stronger as well,” said Dr. Drakos. “Blood flow restriction therapy is an accelerated rehabilitation protocol. The therapy essentially creates an environment in the muscle where it makes the muscle work as hard as if it is lifting heavy weights when it is lifting smaller weights. Cutting off the blood flow tricks the muscle into working harder than it actually would be doing.”

Achilles rupture often presents a difficult recovery for patients, who commonly suffer a 10% to 30% strength reduction in the affected leg up to one year postoperatively. “Achilles rupture is really common in people who do explosion types of sports such as basketball, football and soccer, any sport where you are doing a lot of cutting,” said Dr. Drakos. “With regards to Achilles injuries, once you put the tendon back together, you can’t stress it right away or that will pull the repair apart. Regular rehabilitation can’t start until six weeks after surgery. Unfortunately, this can lead to significant muscle atrophy, which can take months to recover. Blood flow restriction therapy allows us to work the muscle right away, so it doesn’t atrophy and shrink. It safely allows the muscle to see some loading and develop more muscle, so that it can actually start to recover while the tendon is not completely healed yet.”

Blood flow restriction training is believed to bring about strengthening and hypertrophic (muscle building) effects similar to those achieved through completion of high-intensity training, but at significantly lower load intensities. In healthy elderly populations, studies have shown increases in muscle strength when using BFR therapy in combination with low-intensity exercises. Research on the usefulness of BFR therapy with lower-intensity exercises in postoperative populations is in the early stages, with some studies showing benefit for individuals undergoing anterior cruciate ligament (ACL) reconstruction. Specifically, BRT therapy in the early postoperative period of ACL reconstruction has been shown to decrease atrophy and increase strength in the quadricep, when compared with immobilization and a physical therapy protocol. A study investigating the use of BFR therapy following knee arthroscopy also demonstrated a greater increase in strength and thigh girth when compared to a control group. To date, the use of BFR therapy for Achilles rupture rehabilitation has not yet been studied in a quantitative and prospective fashion.

The new BFR study is recruiting 60 patients, all of whom will have Achilles tendon repair surgery by Dr. Drakos. Half of the patients will receive BFR therapy and half will receive standard rehabilitation therapy involving range of motion exercises at two weeks and muscle-building exercises at six weeks. In the BFR therapy group, a blood pressure cuff will be placed on the thigh of a patient while they start their rehab on post-op day two with exercises such as ankle range of motion, leg extensions, leg curls and leg press.

“We think that an ounce of prevention is worth a ton of cure,” said Dr. Drakos. “If we can prevent the muscles from atrophying, which they would normally do after a surgery, and we can prevent that from happening in a safe and structured fashion, then this will help our patients get better faster. Usually, you can’t start rehab until six weeks after surgery.”

The cuff allows some blood flow into the muscle, but prevents much of the venous blood flow return, so the muscle engorges with blood. “Ultimately, what this does is that a lot of the metabolites that encourage growth, including growth hormone, end up being sent to the areas to encourage hypertrophy,” said Dr. Drakos. “Normally, if you want to make your muscles larger, you have to work with heavy weights. If you work out with light weights, you usually get toned, but you usually don’t get large increases in muscle mass. What blood flow restriction therapy allows you to do is use low weight but still get the same effect you would with large weights.”

A Cybex testing machine will objectively quantify changes in muscle strength, measuring how quickly the muscles fatigue and measuring their peak strength. All BFR therapy sessions will be supervised by a physical therapist certified to administer the therapy to ensure safety. To date no significant negative side effects have been observed, however, this technique needs to be further researched to evaluate this. To minimize risks to patients and maximize safety, the BFR device used for therapy individualizes the tourniquet pressure for each patient to be between 60% and 80% of their limb occlusion pressure. Study criteria include active patients who are undergoing Achilles surgery for an acute tear without significant medical co-morbidities.

Other members of the research team include Stephanie Eble, BA, Oliver Hansen, BA, and Andrea Papson, DPT.

"The fibula has a high healing rate, and with surgeries there are potential complications concerning infection, painful hardware, bad wound healing," said Mark C. Drakos, MD, foot and ankle surgeon at HSS, who did not treat Wallace. 

Read the full article at Philly.com.

Dr. Drakos, who did not treat Eifert, explained that the recovery time from a broken ankle is typically four to five months.

"Usually, it takes about six weeks for bones to heal. If there's ligament damage, that takes one to two months. Then you can do some activities in a boot and biking at that point. By three months or so [the athlete] should hopefully be out of the boot and start doing light activity," said Dr. Drakos.

Read the full article at Cincinnati.com.

Dr. Drakos, who did not treat Gregorius, said "the bad part is you can't put weight on it. But it's better than if the bruise was on the balls of his feet because athletes rely more on that area for running."

According to the article, bruised heels could be treated with ice and anti-inflammatories.

Read the full article at nypost.com. This also appeared in the August 21, 2018 print issue.

HSS foot and ankle surgeon Mark C. Drakos, MD, who did not treat Reed, noted that sesamoid removal surgery is typically the final treatment option.

He explained that if bones break and don't heal then "we'll go in and fix them with plates and screws".

"They're very little bones. These are so small that a lot of times we just take it out because it's quicker. It's a quicker recovery," said Dr. Drakos.

Read the full article at usatoday.com.

Additional Coverage:

• The New York Times: Redskins' Reed feeling better after removal of toe bones

Dr. Drakos told OTW, "cartilage injuries continue to be challenging issues to treat for orthopedic surgeons. The current treatment of microfracture (MF) has several shortcomings including mixed long-term outcomes. We were looking to improve upon the current standard of care by using some of the newer allograft technologies."

According to the article, Dr. Drakos and his colleagues compared the results of patients treated with microfracture versus patients treated with DeNovo NT for juvenile allogenic chondrocyte implantation (ACI) with autologous bone marrow aspirate (BMAC).

"The most important results were that there was no difference in either clinical outcome or radiographic appearance between using the juvenile particulate cartilage allograft and the conventional microfracture technique," he explained.

Read the full article at ryortho.com [subscription required].

"The purpose of this article to evaluate arthroscopic techniques for treating talar osteochondral lesions. The current standard of care in the country is still microfracture, and there are ample amounts of data that show it may not be the best intervention for the long-term health of the cartilage," said Dr. Drakos.

Dr. Drakos and his team found that the size difference of the microfractures in the separate study groups had no impact on outcomes.

Listen to the full interview at footandankle.sage-publications.libsynpro.com